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Erectile dysfunction is the inability to achieve and maintain an erection adequate for satisfactory sexual functioning.Sildenafil, Viagra The prevalence of erectile dysfunction increases with age. Prevalence is 5% at age 40, increasing to 15-25% at age 65 and older erectile dysfunction, sildenafil, viagra, vigra.

Physiology of Erection

Parasympathetic input initiates erection by dilation of the helicine arteries of the penis and entrapment of blood.

Flaccidity occurs after constriction of the helicine arteries is induced by sympathetic innervation.

Psychological processes such as depression, anxiety, and relationship problems can impair erectile functioning.

Peyronie's Disease: Formation of plaques or thickening causes curvature of the penis; most commonly occurring in men older than 40, and causes painful erections, inability to achieve full erection, and difficulty in vaginal penetration.

Evaluation of Erectile Dysfunction

Determine frequency of sexual difficulties and duration of problem; gradual or sudden onset. Quality, frequency, and duration of erections; presence of nocturnal or morning erections; ability to achieve sexual satisfaction, and ejaculation with masturbation.

Home and work stress, use of tobacco, alcohol, and recreational drugs are evaluated.

Psychosocial Factors: Performance anxiety, the nature of sexual relationships, and current sexual techniques should be documented.

Medical Conditions

Diabetes mellitus, hypertension, vascular disease, hypercholesterolemia, neurogenic disorders, depression, alcohol ingestion; renal failure. Vasectomy has not been associated with an increased risk of erectile dysfunction. Pelvic trauma or surgery. Acute or chronic prostatitis, radical prostatectomy and external radiotherapy. Note when the medication was begun, for what condition, and at what dosage.

Drugs Associated with Erectile Dysfunction:

Addictive Substances: Alcohol, marijuana, cocaine, heroin, methadone, tobacco

Antihypertensive Agents: Beta-blockers, calcium channel blockers, diuretics, especially thiazides

Psychotropic Agents: Antidepressants, benzodiazepines, lithium preparations, monoamine oxidase inhibitors, phenothiazines, tranquilizers

Other Medications: Antihyperlipidemic agents, chemotherapeutic agents, histamine-receptor antagonists

Physical Examination

Assess general state of health and emotional affect. Observe the gait for neurologic defects. Assess male secondary sex characteristics; femoral and lower extremity pulses.

Signs of a Hormonal Abnormalities: Abnormal hair distribution, gynecomastia, testicular atrophy.

Determine volume, consistency, and symmetry of the testicles; presence of hydrocele or varicocele. Examine the penis for size, sensation, shape; palpate for plaques suggestive of Peyronie's disease. Examine prostate.